International Students’ Expectations and Knowledge of ...hkier.fed.cuhk.edu.hk/journal/wp-content/uploads/2009/10/ajc_v15n1... · International Students’ Expectations and Knowledge

Asian Journal of Counselling, 2008, Vol. 15 No. 1, 3355 The Hong Kong Professional Counselling Association 2009

International Students Expectations and Knowledge of Counseling After Viewing

a Multicultural Counseling Video

Michael J. Scheel, Tanya I. Razzhavaikina, Summer Allen-Portsche, Autumn Backhaus, Soumya Madabhushi, & Melanie Rudy

University of Nebraska Lincoln

International students underutilize counseling services as a method

of coping with the acculturative stress implicit in adaptation to the

unfamiliar environments of U.S. college campuses. Underutilization

is postulated in this study to be related to unfamiliarity with

counseling resources on college campuses, culturally incongruent

expectations of counseling, or lack of knowledge of multiculturally

oriented counseling methods. The investigation explored a method

of increasing international students expectations and knowledge

of counseling using a video that depicts multiculturally competent

practice. The video was based on the common factors model of

multicultural counseling by Fischer, Jome, and Atkinson (1998).

Thirty-seven international students participated and a mixed

methods triangulation design was employed to analyze effects.

Quantitative findings revealed an increase in personal commitment

to counseling after participants had viewed the video. Qualitative

results indicated more sophisticated views of counseling and

expanded knowledge of culturally relevant counseling practices.

Correspondence concerning this article should be addressed to Michael J. Scheel, Department of Educational Psychology, 38 TEAC, University of Nebraska Lincoln, Lincoln, NE 68588-0345, U.S.A. E-mail: [email protected]

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mailto:[email protected]

M. J. Scheel, T. I. Razzhavaikina, S. Allen-Portsche, et al.

The helpfulness of outreach programs that emphasize culturally

responsive services with international students on college campuses

is discussed.

An estimated 582,984 international students, accounting for 4% of the total enrollment, attend U.S. colleges and universities (Institute of International Education, 2007). As students in a foreign land, these individuals are faced with many difficult stressors beyond those of the average U.S. college student. International students must undergo social, academic, and psychological adjustments (Mallinckrodt & Leong, 1992; Parr, Bradley, & Bingi, 1992; Razzhavaikina, 2006; Sandhu, 1994). Berry (1998) points out that international students often must cope with acculturative stress and culture shock. Their acculturative stress is represented by loneliness, loss of identity, homesickness, discrimination and prejudice, fear and anxiety, and somatic complaints (Brinson & Kottler, 1995a; Johnson & Sandhu, 2007; Lewthwaite, 1997; Razzhavaikina, 2006). Other challenges include dealing with cultural clashes (Brinson & Kottler, 1995a; Razzhavaikina, 2006), loss of social support systems (Sandhu, 1994), and continuous pressure to acculturate (Atkinson, Morten, & Sue, 1998).

It seems reasonable to assume, when considering the challenges of international students in U.S. universities, that psychological services such as counseling may be beneficial as a means of coping. Research findings support this assumption indicating that students, in general, who obtain services at campus counseling centers are less likely to drop out of school due to poor academic performances and tend to graduate more often (A. C. Frank & Kirk, 1975). Nevertheless, several studies have documented the underutilization of counseling by individuals from minority cultures (Brinson & Kottler, 1995b; Hall & Tucker, 1985; Kim, 1993; Meyer, 1998; Yakushko, Davidson, & Sanford-Martens, 2008),

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International Students and Counseling

and international students use of university counseling centers is consistent with this pattern of underutilization. Harju, Long, and Allred (1998) found that only 14% of the 107 international students who completed a healthcare survey reported using some type of counseling. Boyer and Sedlacek (1989) found similar numbers with only 8% of 230 international students reporting the use of counseling center services. Even though international students must cope with the challenges of successfully handling academic coursework while simultaneously adapting to a different culture, they report a tendency to seek assistance from peers, family, medical professionals, and faculty advisors before professional counselors and psychologists (Bradley, Parr, Lan, Bingi, & Gould, 1995; Aubrey, 1991).

Surprisingly, given international students underutilization of counseling, Leong and Sedlacek (1986) found that international students do possess a basic openness toward counseling. Further confusion arises from Yoon and Portmans (2004) discovery of higher rates of no shows at university counseling centers by international students. Yoon and Portman attribute this to an uneasiness and reluctance toward counseling, and conclude that a gap [exists] between international students basic openness toward counseling and reluctance to seek actual counseling (p. 41). In response to the puzzle created by the co-existence of underutilization, a basic openness toward counseling, and a pattern of no shows possibly due to a sense of uneasiness, Yoon and Portman recommend the use of more innovative methods to overcome fears related to following through with counseling.

Several reasons for international students hesitancy to seek counseling are provided through a review of relevant literature. Among these is a general lack of familiarity with counseling as a helping process (Arthur, 2004; Dadfar & Friedlander, 1982; Flum, 1998; Hall & Tucker, 1985; Hashemi, 1986; Komiya & Eells, 2001; Kunkel, 1990;

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Tedeschi & Willis, 1993). Minority-culture individuals may also hold opposing cultural views about mental illness as acceptable methods of healing (Mori, 2000). Mori (2000) and Boyer and Sedlacek (1989) contend that underutilization by international students is due to their lack of awareness of available campus resources and not understanding the usefulness of counseling as a help-seeking process. Finally, a possible explanation for underutilization might be that counseling services on college campuses are presented from a Western cultural perspective, not from a multiculturally competent orientation. Arthur (2004) argues that university counselors may unintentionally communicate ethnocentric biases to international students. She encourages the use of culturally responsive counseling services in which the cultural values and assumptions of international students are considered in context with their academic and personal experiences on campus.

Despite the view that international students do not see counseling on college campuses as a good cultural match, methods designed to raise expectations and educate international students about counseling as a culturally relevant help-seeking process have not been generated or researched. Presenting counseling within a multiculturally competent context may persuade international students that counseling is an adaptive means of coping with the multiple stressors and challenges inherent in entering a new culture while needing to perform at a high academic level. In addition, multiculturally oriented presentations of counseling may help to overcome the reluctance and uneasiness that international students may possess toward counseling (Yoon & Portman, 2004). Although attention has been devoted to the construction of multiculturally competent models of counseling (e.g., Sodowsky, Taffe, Gutkin, & Wise, 1994; Sue et al., 1982), no descriptions of methods of presenting counseling services to international students or even to a broader audience of ethnically diverse clients were found in a review of literature.

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The method of presenting multiculturally responsive counseling services through a videotape format was examined in the present study. The Fischer, Jome, and Atkinson (1998) multicultural model of counseling was chosen as the basis of the videotape presentation for two reasons. First, the model combines culturally responsive practices with common factors of efficacious psychotherapy. Second, the model strongly emphasizes the development of a working alliance (Horvath & Greenberg, 1989; Horvath & Symonds, 1991) between counselor and client as the foundation of therapeutic work. A strong relationship component is important, because Bradley et al. (1995), in a study of international students expectations of counseling, found that international students wanted honest, genuine, trustworthy, accepting, warm, interpersonally skilled, and empathic counselors. Wampold (2001) explains in The Great Psychotherapy Debate that these counselor characteristics contribute to the primary common factor in therapy, the therapeutic relationship.

This study is specifically concerned with the influence on international students expectations and knowledge of counseling of a videotape presentation of culturally responsive counseling depicted through role-play examples. The research question examined through this study is: What effects does the experience of viewing a muliticultural counseling video have on international students expectations and knowledge of counseling? The investigation can make a contribution to understanding how international students perceive counseling and how receptive they are to the consideration of counseling as a help-seeking option when acculturative stress arises. Findings from this research can potentially assist university counseling centers and other counseling agencies in addressing the problem of underutilization of counseling by international students. In addition, results from this investigation may help to plan outreach programs for international students and recent immigrants. The present study utilizes a mixed methods triangulation

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design (Creswell & Plano Clark, 2007) with both quantitative and qualitative data collected concurrently. Using both qualitative and quantitative data allows for expansion and validation of results beyond what would be possible with only one type of data.

Method

Participants

Forty-six participants started the study, and a total of 37 international students, both graduate (n = 16) and undergraduate (n = 21), completed the pre- and post-assessments. Language proficiency and time were factors in participants ability to complete both sets of assessments within the 90 minutes available for the task. The international student participants attended a large Midwestern U.S. university, and identified themselves as Asian and Pacific Islanders (n = 27), Africans (n = 4), Latino/as (n = 4), and Caucasians (n = 2). Asian and Pacific Islander participants represented 73% of the total sample, a slightly higher proportion than the demographics of international students (i.e., 61%) on this particular university campus and overall in the U.S. (i.e., 58%; Institute of International Education, 2007). The 23 women and 14 men who completed both phases of the research reported lengths of stay in the U.S. from 3 months to 1 year. Eight participants had previous counseling experiences. To recruit participants, researchers visited undergraduate and graduate classes of English Language Learners (ELL) and Intensive English Programs offered by the university. The international students attending these classes were invited to come for lunch at the Counselor Training Clinic on campus, and then participate in the study.

Instrumentation

The two dependent variables, expectations of and knowledge of counseling, were assessed through the Expectations about Counseling

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Brief Form (EAC-B) scale and the Knowledge of Counseling Questionnaire (KCQ), respectively. The EAC-B possesses 66 items with 18 subscales. Subscales are grouped into four factors reported by Tinsley, Workman, and Kass (1980) as (a) personal commitment, (b) facilitative conditions, (c) counselor expertise, and (d) nurturance. The EAC-B was originally constructed to measure five main areas to examine expectations about client attitudes, client characteristics, counselor attitudes and behaviors, counselor characteristics, and counseling process and outcome characteristics. Each EAC-B subscale is scored on a 7-point descriptively anchored Likert-type scale, ranging from 1 (not true) to 7 (definitely true). As reported by Tinsley (1982), the internal consistency estimates of the scales on the EAC-B range from .69 to .82 with a median reliability of .76. Test-retest reliability of the scales ranged from .47 to .87 with a median of .71, using a two-month interval. In the present study, the 13 items of the Realism subscale were dropped from the assessment, due to its experimental nature and lack of validity evidence (Tinsley, 1982).

Knowledge of counseling was measured through the KCQ. Because no instruments that assess knowledge of counseling are presently available, the KCQ was specifically written for this study to assess participants awareness of (a) appropriate problems for counseling, (b) typical counseling processes, and (c) expectations of the counselor. The KCQ consists of four questions asking respondents to qualitatively describe (a) their perceptions of counseling, (b) their understandings of concerns that may bring a person to counseling, (c) their awareness of qualities that a counselor might possess, and (d) their overall expectations of counseling. Due to its qualitative nature, the KCQ requires a content analysis to gain group outcomes.

Acculturation was viewed as a possible mediator variable in this research that may act to influence expectations of counseling. Therefore,

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acculturation was measured through the Stephenson Multigroup Acculturation Scale (SMAS; Stephenson, 2000). The SMAS consists of 32 items assessing behavioral and attitudinal aspects of acculturation that can be applied across ethnic groups. Responses to each item are scored on a 4-point descriptively anchored Likert-type scale, ranging from 1 (true) to 4 (false). The SMAS is scored according to two subscales: Ethnic Group Identification (EGIS) and Dominant Group Identification (DGIS). Lower scores reflect greater acculturation with either the respondents ethnic group or with the dominant culture group. Stephenson (2000) reported Cronbach alphas of .94 and .75 with the EGIS and DGIS factors respectively.

Demographic information was collected via five questions included in the EAC-B scale (i.e., year in school, age, sex, race, previous counseling experience) constituting nominal level data.

Procedure

All participants signed an informed consent statement approved by the university institutional review board indicating their willingness to be in the study. Participants who came for lunch at the Counselor Training Clinic were asked to complete the EAC-B, the SMAS, and the KCQ, and then view a 15-minute videotape depicting multiculturally competent counseling practices. After viewing the video, they again were asked to complete the EAC-B and the KCQ. This procedure was designed to assess participants expectations and knowledge of counseling before and after the video presentation. Nine individuals were not able to complete the post-treatment questionnaires due to time constraints, leaving a total of 37 participants completing both the pre- and post-assessments.

Production of the Multicultural Counseling Videotape. Fischer et al.s (1998) theoretical model of multicultural counseling formed the

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basis for a production of the Multicultural Counseling Video that was used in this study. Fischer et al.s model combines common factors of therapy (J. D. Frank & Frank, 1991) with treatments shaped to be good fits for specific cultures. As Fischer et al. state, the model is a skeleton of universal healing factors [that] requires the flesh of cultural knowledge (p. 525). The model offers etic approaches to counseling such as aspects of person-centered therapy to build rapport and a working alliance with the client and emic approaches that are culturally relevant for a specific cultural group such as Network Therapy for Native American clients. The authors of the model stress the need for a positive healing relationship requiring cultural sensitivity. Four factors comprise the model. The first factor is the therapeutic relationship, and is demonstrated in the video by therapist warmth, genuineness, and empathy (Torrey, 1986). The second factor is shared worldview, which means sharing similar languages and thought processes, as well as similarly understanding causative forces in the world and classification systems of psychological problems (Torrey, 1986). The third factor is client expectations and is communicated in the video as hope or faith in the counseling process. The last factor is ritual or intervention, and represents a therapeutic change process that is culturally relevant for the client. Culturally relevant interventions in the video are depicted through the use of client language, religion, and food.

Narration and role-plays are used in the video to present purposes for counseling, typical reasons for coming to counseling, culturally relevant interventions, and processes that clients should expect when seeking counseling. Graduate students in counseling representing several ethnic groups and countries played the roles of clients and counselors. Four scenes were role-played. Scene One takes place in a residence hall cafeteria in which one friend tries to convince a second friend to seek counseling at the counseling clinic on campus by explaining the available services, expectations, and benefits that can be

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derived. Scene Two involves an intake interview in which the counselor explains confidentiality and demonstrates methods of building client trust. Scene Three demonstrates an individual counseling session in which the counselor uses rapport-building and culturally appropriate interventions. Scene Four depicts a support group for international students. Clients of the group explain stressors and anxieties that are typical of international students, and the group counselor offers reassurance about the value of counseling in addressing their worries.

During and after production of the Multicultural Counseling Video, validity checks were conducted using three counseling psychologists as expert judges to determine whether the role-play enactments accurately depicted Fischer et al.s (1998) Multicultural Counseling Model. The three judges offered feedback and suggestions during the making of the videotape and upon completion of the video concurred that it represented a valid example of Fischer et al.s model.

Results

A mixed methods triangulation design was employed for the analysis. Creswell and Plano Clark (2007) see the purpose of this design as bringing together complementary data. Complementary in that the strengths and weaknesses of quantitative and qualitative data are combined to more thoroughly address the research question. They further state that this design is used when a researcher wants to directly compare and contrast quantitative statistical results with qualitative findings or to validate or expand quantitative results with qualitative data (p. 62). In this study, the weakness of the quantitative design was the lack of statistical power caused by the relatively small sample size. The qualitative data provided a chance to achieve more depth of understanding of quantitative results as well as a means of validation of the quantitative findings.

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Quantitative Analysis

Table 1 displays the means, standard deviations, and t-tests for each of the factor scores of the EAC-B as well as means and standard deviations for the acculturation scores of the SMAS. Paired comparisons of mean scores of the factor scales of the EAC-B before and after viewing the video were conducted. Personal commitment was significantly higher after viewing the videotape (t (36) = 2.04, p < .05). Although higher scores were also found after viewing the video for the other factor scales (facilitative conditions: t (36) = .53, p > .05; counselor expertise: t (36) = .80, p > .05; nurturance: t (36) = .59, p > .05), differences were not statistically significant. Results from the SMAS did not correlate significantly with any of the factor scales of the EAC-B at pre- or post-viewing times, indicating that acculturation in either ones own culture or in the dominant culture did not mediate participants expectations of counseling.

Table 1. Means, Standard Deviations, and t-test Values for the Paired Comparisons of Factor Scores of the EAC-B and Acculturation Scores of the SMAS

Variable M SD t-test

EAC-B factor scores Pre-personal commitment 4.79 .82 Post-personal commitment 5.03 .96 2.04* Pre-facilitative conditions 5.35 .82 Post-facilitative conditions 5.40 .89 .53 Pre-counselor expertise 4.72 1.19 Post-counselor expertise 4.83 1.27 .80 Pre-nurturance 4.80 .97 Post-nurturance 4.87 .72 .58

SMAS scores Ethnic group acculturation 20.02 2.88 Dominant group acculturation 14.99 3.09

* p < .05

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Qualitative Analysis

Qualitative data were collected via pre- and post-treatment administration of the KCQ, and analyzed through content analysis. After removing participant files with missing qualitative data (n = 4), the total of 42 KCQ pre-assessments and 37 KCQ post-assessments underwent qualitative analysis. The analysis included five steps: (a) jotting down ideas regarding possible code categories and connections between them; (b) writing memos; (c) developing diagrams and tables that compare pre- and post-assessment responses; (d) developing specific codes; and (e) sorting codes into thematic categories (Bogdan & Biklen, 1992). The results of the content analysis were validated through an inter-coder agreement process (e.g., Miles & Huberman, 1994). The inter-coder agreement involved two phases. During the first phase, four researchers independently coded and analyzed all answers to KCQ questions utilizing the same data analysis strategy. During the second phase, the researchers compared the codes and themes, discussed each theme and developed a consensus regarding the final themes and codes. The goal of the content analysis was two-fold. First, in analysis of pre-treatment KCQ responses, coders wanted to identify themes for each area that was assessed (i.e., purpose of counseling, reasons to seek counseling, counselor qualities, and client expectations). Second, in analysis of post-treatment KCQ responses, coders were looking for new codes and themes that emerged from the data in comparison with pre-treatment codes.

Table 2 displays the pre- and post-assessment themes. Generally, the analysis of the post-treatment responses revealed three to four new themes beyond those identified in the pre-assessment for each of the four areas of the KCQ. The Purpose of Counseling area of the KCQ revealed more specific knowledge of counseling in post-treatment when comparing pre- to post-treatment themes. For instance, a female

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Table 2. Pre- and Post-treatment Themes (Qualitative Analysis)

Pre-treatment themes New post-treatment themes

Question 1: Purpose of counseling 1. Problems

talking about and solving talking about worries

2. A means to feel better gain relief from problem

3. Opportunities to get an advice

1. Talking about feelings 2. Help with identifying problems and

solutions 3. Understanding self

Question 2: Reasons to seek counseling 1. Relationship problems 2. Talk about experiences and be

listened to 3. Academic concerns

1. Sleep disorders 2. Cultural problems

culture shock, immersion in dominant society

adjustment to a new culture 3. Depression 4. Weight fluctuation

Question 3: Counselor qualities 1. Trustworthy 2. Knowledgeable 3. Friendly 4. Patient 5. Kind

1. Easygoing 2. Warm 3. Familiar with my culture 4. Honest

Question 4: Client expectations 1. Feel listened to 2. Be treated in a friendly manner 3. Get new ideas for solutions 4. Be respected

1. A confidential atmosphere 2. Advice getting 3. Unconditional positive regard

participant wrote in her pre-KCQ: [counseling] Helps people to answer questions and get out from troubles. In her post-assessment she noted: [counseling is] A place [sic] can help with your relationship problems, depression problems, lonely [sic] problems. The category of Reasons to

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Seek Counseling produced more reasons as well as a greater variety of reasons after viewing the video. For example, in his pre-treatment response to the KCQ question, a male participant wrote: Bad relationship with others, studying problem, own character, and disability or weak point. The same male student wrote after viewing the video: Sleeping problems, weight problem, diversity problem, isolated feelings, studying problem, relationship with others, minority, depression. For Counselor Qualities in the KCQ, respondents became more aware after viewing the video that the counselor would be concerned with the incorporation of the clients culture as evidenced by the theme familiar with my culture. In the fourth area of the KCQ, analysis of the post-treatment responses revealed three new themes to the Client Expectations area. Two of these, confidential atmosphere and unconditional positive regard, demonstrate a seemingly more advanced understanding of the professional and ethical issues of counseling than in the pre-assessment. For instance, a male participant wrote: I want counselors to be kind and I do not want them to just say You are bad at this point or something like that Treat me as a person, not like a problem. A female responded in her post-assessment: I would expect to be treated friendly [sic], in a comfortable and confidential way.

Discussion

This research involved the investigation of international students perspectives toward counseling as a help-seeking alternative using a video presentation of counseling within a culturally relevant context. The implementation of this type of study is important for at least three reasons. First, international students experience acculturative stress while in the midst of academic pursuits. Second, international students, like many culturally diverse students, tend to underutilize professional counseling services on university campuses. And third, little attention has been given either through research or in practice to the development

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of specific methods designed to change international students expectations of counseling or increase their knowledge of help-seeking resources on college campuses that could be useful to them as a means of coping with acculturative stress. This study was unique in that it explored client constructions of the cultural relevance of counseling. Only a study by Pope-Davis et al. (2002) has previously examined the social constructions of potential clients in reference to the multicultural counseling area.

Quantitative results demonstrated change in the personal commitment of international students to the process of counseling after viewing the video of Fischer et al.s (1998) multicultural framework of counseling. Fischer et al.s theoretical model was demonstrated through this video production to be a workable framework for presenting a multiculturally competent orientation to counseling. Because we found the four factor model of multicultural counseling to be easily transferable to a video format, we encourage university counseling centers to employ this type of presentation in outreach programs for international students.

While the personal commitment to counseling by the international students in this study changed significantly from pre- to post-treatment, none of the other three factors of the EAC-B showed differences that could be attributed to anything more than chance occurrences. The qualitative results supported the findings regarding increased personal commitment and provided richer descriptions of participant meanings concerning their personal commitment to counseling. Through our qualitative analysis, we detected a less informed view of counseling before the video. Students generally viewed counseling narrowly as a problem-solving device or a place to get advice. After the video presentation, expanded perspectives of counseling included additional purposes for counseling, a means of gaining self-understanding, and the expression of feelings in counseling. International students also made shifts in understanding from counseling seen as someone telling a

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person what to do to counseling as a collaborative process in which a counselor works with a person to help him or her to figure out what is best. They also discovered counseling to be a place to talk about their experiences with culture shock and struggles to adjust to a new culture. In addition, they expressed an informed view that counselors may be able to understand their culture. They seemed to understand from the video that counseling is different than talking with a friend, because counseling is done in a professional manner (e.g., protection of confidentiality). Each of these new insights derived from viewing the video were positive perceptions of counseling as a help-seeking process, and could conceivably contribute to greater utilization of counseling. The qualitative analysis also revealed that after viewing the video, students gained a new perspective of counseling as culturally responsive.

The differences in qualitative data before and after viewing the video indicate openness by the students to the incorporation of new information about counseling. If, indeed, international students on U.S. college campuses are open to new ideas about help-seeking, outreach programs targeting international students seemingly have a good chance of being successful.

While we regarded the findings of our study to be informative, we also are aware of several limitations. Our sample size was relatively small, and this may have been related to our method of recruitment. We struggled to get students to participate in the study. International students are very busy, and may also be hesitant to participate in research about counseling when it is unfamiliar to them. This may be especially true of students who do not see counseling as a potentially helpful resource. Our sample only consisted of students who were in English Learner classes, and some of the participants demonstrated a lack of English language proficiency in completing the questionnaires. Consequently, some of them ran out of time in their efforts to complete the

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questionnaires. In addition, the turnaround time between pre- and post-assessments was short, and did not allow for deeper reflection of the content in the video by the participants. The result of a statistically significant change in personal commitment to counseling is noteworthy, especially when considering the short amount of time between the two administrations of the EAC-B.

A second major limitation was the lack of a control group who did not receive the video treatment. Without a control group, we are unable to conclude that changes in expectations and knowledge of counseling were due to the treatment. We must consider that these changes may have come from a simple recall effect, in that the period of time was short between the two administrations of questionnaires. Likewise, a viable explanation for differences could be due to a social desirability effect. Participants may have provided answers after viewing the video that they believed to be the right answers instead of responses that were valid for the individual participant. Without a control group, it was not possible to clearly and unequivocally know the influence of our treatment.

Strengths of this study included the mixed method of inquiry that combined quantitative and qualitative results. The difficulty of the lack of statistical power to detect differences if they truly exist in a small sample may have been partially overcome by the use of qualitative methods that allowed us to examine the reasons for the responses to the quantitative instruments. Lack of statistical power may also have contributed to not finding a relationship between acculturation as measured by the SMAS and counseling expectations. Consequently, we encourage future studies to continue to examine the effect of acculturation on perceptions of counseling.

In conclusion, we believe findings from this study are important despite its inherent limitations. Findings demonstrate that a presentation

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of counseling using a multicultural orientation has potential to educate, increase awareness, and broaden the view of counseling as a viable method for seeking help for international students. This study also is important as a starting point for the investigation of counseling utilization by international students. Little attention has been given to outreach programs for international students in U.S. colleges and universities. It is our hope that this study will spur more investigations of international students perceptions of counseling and methods of increasing the use of counseling services to international students.

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